70 y.o. halthy and active
woman (colleague's mother) complaining by some weeks of crisis of cold
sweating, consciousness disturbances and arterial hypotension. These
symptoms appear on fasting (early morning) and go away with i.v. glucose
infusion. Insulin/glucose ratio during crisis close to 1. On ct scan an "
enlargment of pancreatic uncinate process, and irregularity in gastric
wall". LFT normal. US: Non dilated CBD, no stones in gallblader.
Gastroenterologist performed gastroduodenoscopy and ERCP (pancreatogram
could no be done) that were normal.
We are planning surgical
exploration. If certainly tumor is located in uncinate process, what to do?:
1) Whipple operation
2) Resect only uncinate process. Is it possible?. Any references about?